OMNIA℠ Health Plan
OMNIA Health Plans offer significantly lower premiums and no referrals when accessing the largest network in New Jersey. Plus, members can save even more with lower out-of-pocket costs at certain doctors and hospitals.
As an OMNIA℠ Health Plan member, when you use OMNIA Tier 1-designated doctors, hospitals and other health care professionals, you’ll get the benefit of patient-centered care — an innovative approach to health care delivery that is providing more organized, personalized and coordinated care, made possible by the secure sharing of information and experiences among the doctors, other health care professionals and hospitals that treat you. The ultimate goal? Helping to ensure you get and stay healthy, while keeping costs under control, too.
While your OMNIA Health Plan encourages you to get care from OMNIA Tier 1-designated doctors, hospitals and other health care professionals, your plan covers all medically necessary care and services provided or arranged by doctors and other health care professionals in the Horizon Managed Care Network, and all hospitals in the Horizon Hospital Network.
Patient-centered care is an approach that helps you get the quality health care you deserve while keeping costs under control, too. The doctors and practices that participate in OMNIA Health Plans have committed themselves to increasing patient satisfaction and achieving quality health outcomes. When you select an OMNIA Tier 1-designated doctor as your doctor, you can expect:
- A doctor who takes overall responsibility for your care while directing the team of health professionals involved in your overall care
- Wellness services and preventive care based on national guidelines, including wellness support and resources
- Preventive services, screenings and immunizations that are fully covered when you receive them from your doctor or another in-network doctor
Your OMNIA Health Plan does not require you to select a Primary Care Physician (PCP) or get a referral for specialty care. However, choosing an OMNIA Tier 1-designated PCP means you will have a doctor who takes overall responsibility for your care while directing the team of health professionals involved in your overall care. Choosing an OMNIA Tier 1-designated PCP can also be helpful in lowering your out-of-pocket cost sharing.
Members can locate in-network OMNIA doctors and hospitals using our Doctor & Hospital Finder. You’ll pay less when you select and see OMNIA Tier 1 doctors, specialists and hospitals. You can identify OMNIA Tier 1 doctors, specialists and hospitals by looking for the blue icon pictured here.
OMNIA TIER 1
All other doctors, specialists and hospitals will be listed as Tier 2, with this gray icon.
Remember: Services provided by doctors, hospitals and other health care professionals that do not participate in OMNIA Health Plans are not covered. You’ll be responsible for the total cost of any of the out-of-network services you receive (except in the case of an emergency).
Check your member ID card or refer to your benefit booklet for specific out-of-pocket costs, benefit information and exclusions.